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Share Your Story

  1. Select date

  2. Please use this form to submit your story with the Rockledge Police Department with regard to the circumstances that you recognized someone for actively caring for people, or the circumstances of how someone recognized your actions with an AC4P wristband.

  3. The Rockledge Police Department encourages AC4P wristband recipients to "pay it forward" by recognizing others for actively caring for people. To receive a free replacement AC4P wristband from the Rockledge Police Department, you MUST provide a valid email address for a representative to contact you in order to provide you with a replacement AC4P wristband.

  4. Enter a valid e-mail address

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